The Voice of Betsy Seals

Betsy Seals

About Betsy Seals

Betsy Seals is Chief Consulting Officer at Gorman Health Group. She is an experienced Medicare managed care compliance professional who brings Gorman Health Group clients more than a decade of operational experience and compliance expertise.

The Open Enrollment Period Changes Everything

Betsy Seals

Within the Final Rule, the Centers for Medicare & Medicaid Services (CMS) confirmed the reinstatement of the Open Enrollment Period (OEP), which allows a one-time enrollment election from January 1 – March 31 beginning in 2019. For those of us who have been in Medicare Advantage (MA) for a while, we may have had a few déjá vu moments with this announcement (or was that just me?). When we start really thinking about the reinstatement of the OEP, we may be tempted to dust off those old OEP strategies. However, from our perspective, reemploying old strategies would be a mistake. For new plans, or those new to MA, who have never been through an OEP, there is even more to consider from a strategic perspective. While we wait for the Final Medicare Marketing and Communication Guidelines, as well as the Enrollment Guidance, which will tell us where the OEP will fall in the hierarchy of enrollment periods – here are some things to start thinking about:

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Is it the End of the Medicare Marketing Guidelines as we Know Them?

Betsy Seals

For those of us who have worked for years in the marketing and sales arena, the release of the Centers for Medicare & Medicaid Services (CMS) memo, “Request for Input on the 2019 Medicare Communications and Marketing Guidelines,” on April 12, 2018, somehow felt like the end of an era. In this memo, CMS confirms the Medicare Marketing Guidelines (MMG) will be renamed the “Medicare Communication and Marketing Guidelines.”

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2018 Medicare Marketing Guidelines – The Final word on Agency Compensation

Betsy Seals

If there is one thing we can always count on, it’s that the Centers for Medicare & Medicaid Services (CMS) will keep us on our toes!

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Agent Compensation Changes in the Draft 2018 Medicare Marketing Guidelines

Betsy Seals

While the industry patiently awaits the Final 2018 Medicare Marketing Guidelines (MMG), learn which draft guidelines could have a huge impact on the industry if made final.

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Agent Commission: Don’t find yourself on the wrong end of the tipping point

Betsy Seals

Agent compensation for Medicare Advantage has changed drastically since the implementation of the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. MIPPA included regulations, for the first time, around Agent/Broker Commission – among many other things. The goal of implementing commission requirements was to ensure there was a level playing field between plans by implementing the Fair Market Value (FMV) limits, thereby removing the incentive for agents/brokers to enroll a beneficiary into the top-paying plan or to churn beneficiaries from one plan to another. Rather, the goal was to ensure the beneficiary was enrolled in the plan that best fit his/her needs.

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2016 Marketing Guidelines: Evolve or Pay

Betsy Seals

There were several significant changes released in the 2016 Medicare Advantage & Part D Medicare Marketing Guidelines (MMGs), all of which communicate the same consistent message from the Centers for Medicare & Medicaid Services (CMS), the focus is on the beneficiary.

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CMS Releases the 2015 Audit Protocol: Critical Next Steps to Avoid Becoming A Casualty of Reasonable Expectations

Betsy Seals

On February 12th, CMS released the 2015 Audit Protocol. The question on everyone’s mind is — what does this mean for 2015? Well, it means a few things. Outlined below are some of the most impactful changes, as well as the “why” behind the change, and the trends that continue to emerge.

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